Abstract
Patient-specific rehearsal (PsR) is a new concept whereby a procedure can be rehearsed virtually using the exact patient’s anatomical data prior to performing the real procedure. The aim of this study was to ascertain if endovascular virtual-reality PsR simulation enhanced performance in real life. This was done by performing a systematic review following the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A literature search was conducted in PubMed, Embase, The Cochrane Library and Web of Science concerning PsR in endovascular procedures. All publications were handled using Covidence. Reference lists were also screened. Data extracted from the studies were realism rating, procedure time, fluoroscopy time, contrast volume, number of angiograms and reduction of errors. Kirkpatrick’s four-level model for measuring the efficiency of training was used for guidance of the relevance of studies. The search yielded 1155 results after the exclusion of duplicates, and 11 studies were included. Four studies had a control group, including one randomized trial; the remaining seven were feasibility studies. The realism was rated high, and overall, the studies showed improvements in procedure time, fluoroscopy time and contrast volume after PsR. One study assessed and confirmed the reduction in errors after PsR. Only two studies included more than 15 patients in their cohort. Kirkpatrick’s model was applied to all studies, with one study reaching level 4. All studies found the concept of PsR to be feasible and realistic. The studies with a control group showed a reduction of overall procedure time, radiation exposure and potential errors in endovascular procedures following PsR.
Highlights
Simulation is deeply rooted in the aviation industry, where it is used in pilot assessment and certification [1,2]
The benefits of virtual reality simulation training are clearly demonstrated in several surgical fields, but as of yet, these simulations have been based on generic cases rather than focusing on the specific patient [4,5,6,7]
The results show higher scores in the studies with a control group, indicating a lower risk of bias
Summary
Simulation is deeply rooted in the aviation industry, where it is used in pilot assessment and certification [1,2]. All pilots undergo training and recertification in a simulator every six months, where they are exposed to a wide range of flight conditions [1]. Simulation is incorporated into the healthcare system as a tool to improve skills and increase patient safety [3]. The benefits of virtual reality simulation training are clearly demonstrated in several surgical fields, but as of yet, these simulations have been based on generic cases rather than focusing on the specific patient [4,5,6,7]. It is important to remember that simulation training cannot replace the traditional apprenticeship model
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